| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Department of Intensive Care Medicine (G.V.d.B., D.V.R., P.V., P.J.W.), Pharmacy (L.D.P.) and Laboratory for Experimental Medicine and Endocrinology (R.B.), University of Leuven, B-3000 Leuven, Belgium
Address correspondence and reprint requests to: Greet Van den Berghe, M.D., Ph.D., Department of Intensive Care Medicine, University of Leuven, B-3000 Leuven, Belgium. E-mail: greta.vandenberghe{at}med kuleuven.ac.be.
In prolonged critical illness, increased bone resorption and osteoblast dysfunction have been reported facing low 25 hydroxy vitamin D [25(OH)D] concentrations. The current study investigates the extent to which lack of nutritional vitamin D and time in intensive care contribute to bone loss in the critically ill. Prolonged critically ill patients (n = 22) were compared with matched controls and then randomized to daily vitamin D supplement of either ± 200 IU (low dose) or ± 500 IU (high dose). At intensive care admission, serum concentrations of 25(OH)D, 1,25 dihydroxyvitamin D3, vitamin D-binding protein, ionized calcium, IL-1, and soluble IL-6-receptor were low, and PTH was normal. Circulating type-I collagen propeptides were high, alkaline phosphatase was normal, and osteocalcin was low. Bone resorption markers [(carboxy terminal cross-linked telopeptide of type I collagen (ßCTX), pyridinoline, deoxypyridinoline (DPD)] were 6-fold increased. Serum C-reactive protein (CRP) was 40-fold, IL-6 400-fold, TNF
levels 5-fold, and osteoprotegerin concentrations 3-fold higher than in controls. Soluble receptor activator of nuclear factor 
B ligand was undetectable. High-dose vitamin D only slightly increased circulating 25 hydroxy vitamin D (P < 0.05), but 1,25 dihydroxyvitamin D3 was unaltered. High-dose vitamin D slightly increased serum osteocalcin (P < 0.05) and decreased carboxy terminal propeptide type-I collagen (P < 0.05) but did not affect other bone turnover markers. Bone-specific alkaline phosphatase, urinary pyridinoline and DPD, and serum ßCTX markedly increased with time (P < 0.01). Circulating CRP and IL-6 decreased with time, whereas TNF and IL-1 remained unaltered. The fall in CRP and IL-6 was more pronounced with the high- than low-dose vitamin D (P < 0.05). Except for a mirroring of ßCTX rise by a fall in osteoprotegerin, cytokines were unrelated to the progressively aggravating bone resorption. In conclusion, prolonged critically ill patients were vitamin D deficient. The currently recommended vitamin D dose did not normalize vitamin D status. Furthermore, severe bone hyperresorption further aggravated (up to 15-fold the normal values) with time in intensive care and was associated with impaired osteoblast function.
This work was supported by grants from the Belgian Research Foundation F.W.O.-Vlaanderen [G.0144.00 and G.3C05.95N (to G.V.d.B.) and G.0241.01 (to R.B.)] and the University of Leuven (OT/99/32 to G.V.d.B.).
This work was presented in part at the 15th Annual Congress of the European Society of Intensive Care Medicine, September 29 to October 2, 2002, Barcelona, Spain.
Abbreviations: CRP, C-reactive protein; ßCTX, carboxy terminal cross-linked telopeptide of type I collagen; CV, coefficient of variation; DBP, vitamin D-binding protein; DPD, deoxypyridinoline; ICU, intensive care unit; OC, osteocalcin; 1,25(OH)2D, 1,25 dihydroxyvitamin D3; 25(OH)D, 25 hydroxy vitamin D; OPG, osteoprotegerin; PICP, carboxy terminal propeptide of type I collagen; PINP, amino terminal propeptide of type I collagen; PYD, pyridinoline; sALP, bone-specific alkaline phosphatase; sIL-6-R, soluble IL-6 receptor; sRANK-L, soluble receptor activator of nuclear factor-B ligand.
This article has been cited by other articles:
 |
|
 |
|
  G. Schwalfenberg Not enough vitamin D: Health consequences for Canadians Can Fam Physician, May 1, 2007; 53(5): 841 - 854. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. Pittas, S. S. Harris, P. C. Stark, and B. Dawson-Hughes The Effects of Calcium and Vitamin D Supplementation on Blood Glucose and Markers of Inflammation in Nondiabetic Adults Diabetes Care, April 1, 2007; 30(4): 980 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. D. Michos and R. S. Blumenthal Vitamin D Supplementation and Cardiovascular Disease Risk Circulation, February 20, 2007; 115(7): 827 - 828. [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Hollander and J. I. Mechanick Nutrition Support and the Chronic Critical Illness Syndrome Nutr Clin Pract, December 1, 2006; 21(6): 587 - 604. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Rittweger, K. Winwood, O. Seynnes, M. de Boer, D. Wilks, R. Lea, M. Rennie, and M. Narici Bone loss from the human distal tibia epiphysis during 24 days of unilateral lower limb suspension J. Physiol., November 15, 2006; 577(1): 331 - 337. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Cigolini, M. P. Iagulli, V. Miconi, M. Galiotto, S. Lombardi, and G. Targher Serum 25-hydroxyvitamin d3 concentrations and prevalence of cardiovascular disease among type 2 diabetic patients. Diabetes Care, March 1, 2006; 29(3): 722 - 724. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Dietrich, M. Nunn, B. Dawson-Hughes, and H. A Bischoff-Ferrari Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation Am. J. Clinical Nutrition, September 1, 2005; 82(3): 575 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Dietrich, K. J Joshipura, B. Dawson-Hughes, and H. A Bischoff-Ferrari Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population Am. J. Clinical Nutrition, July 1, 2004; 80(1): 108 - 113. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Endocrinology | Endocrine Reviews | J. Clin. End. & Metab. |
| Molecular Endocrinology | Recent Prog. Horm. Res. | All Endocrine Journals |
